A comparison ofrheumatoid arthritis inAustralia and

SUMMARY A comparison was madeoftwoseries ofconsecutive outpatients with a presumptive diagnosis ofrheumatoid arthritis (RA)attending referral centresinMelbourne andShanghai. No significant differences were observed indisease onset, course,presenceofantinuclear antibodies (ANA),or seropositivity. IntheAustralian series there was a higher frequency ofnodules, Raynaud's phenomenon, carpal tunnel syndrome, and'classical' incomparison with'definite' disease, andalower frequency oflymphadenopathy andhepatomegaly. Joint tenderness andsoft tissue swelling tended tobemore markedintheChinese series, whiledeformity andlimited rangeofmovementwere less severe.Drugtherapy was similar overall butinfluenced bydrug availability. Peptic ulceration was recorded in28%oftheAustralian series butinonly6% ofthe Chinese; although 25%oftheChinese were receiving antacids and6% antiulcerants. x Raysof handsandfeetshowed more severedisease intheAustralian series. Theolder age group and longer duration ofthedisease intheAustralian patients, whohadmore chronic andless active disease, may haveinfluenced some oftheseresults. A gooddealofmystery surrounds theprevalence andseverity ofrheumatoid arthritis (RA)inthe Asian andWestern Pacific region. Theidentification ofanyregional differences indisease distribution or clinical features couldprovide important leads to aetiology. Although diagnostic criteria usedin different countries havevaried, prevalence determinations haveshownless variability thanformost diseases. A 15yearlongitudinal population study of RA inJapan,' however, indicated thatbothincidenceandprevalence (the latter being 0-3%) were significantly lowerthaninWestern Europe andthe USA,wheretheprevalence isbetween 1and3%.23 Suchevidence asisavailable indicates thatthe European populations inAustralia andNew Zealandhavefigures similar tothose ofEurope. New Zealand studies suggest thatPolynesians havelower rates ofRA thanEuropean NewZealanders,4 and thereissomelargely anecdotal evidence thatin otherAsianpopulations thedisease ismilder and nodules arerare. A survey ofaChinese population